Ronald Piscotty

Barcode medication administration work-arounds: a systematic review and implications for nurse executives.

Safe medication administration is necessary to ensure quality healthcare. Barcode medication administration systems were developed to reduce drug administration errors and the related costs and improve patient safety. Work-arounds created by nurses in the execution of the required processes can lead to unintended consequences, including errors. This article provides a systematic review of the literature associated with barcoded medication administration and work-arounds and suggests interventions that should be adopted by nurse executives to ensure medication safety.

Nurses' use of clinical decision support: a literature review.

Little is known regarding nurses’ usage of clinical decision support systems. A review of the literature was conducted to understand the extant knowledge surrounding the topic of nurses’ usage of clinical decision support systems. The common themes that emerged from the review of literature on clinical decision support systems usage by nurses include (1) nurse factors affecting usage, (2) patient factors affecting usage, (3) technology and design factors affecting usage, and (4) organizational factors affecting usage. Two major implications are that these systems may not be designed to support nursing practice and may not be having the intended effect on patient care and quality.

Exploring the clinical information system implementation readiness activities to support nursing in hospital settings.

The implementation of clinical information systems can have a profound impact on nurses and their productivity. Poorly implemented systems can lead to unintended consequences that may have a negative impact on clinical processes and patient outcomes. Executives must have adequate knowledge to address nurses’ concerns related to implementation. This study explored the clinical information system implementation readiness activities adopted by chief nurse executivesin hospital settings. A descriptive qualitative design was used, including interviews with six chief nurse executives, held from December 2003 through March 2004. The constant comparative method was used to analyze the interviews to extract readiness activity themes and compare these to the literature. The synthesized themes showed that the executives were knowledgeable about and engaged in several key areas, but not all, of the implementation readiness process. The majority of responses were classified into the thematic areas of champion support, staff preparation for change, training, organizational alignment, planning, and vendor support. The theme of a lack of vendor support was not identified in previous studies but was clear in the responses of the chief nurse executives interviewed.

Nurses’ Assessment of Delirium With Underlying Dementia in End-of-Life Care

Because of physical and metabolic changes during end of life, patients with dementia are very susceptible to develop delirium. The recognition of delirium with underlying dementia can be difficult because of their overlapping behavioral manifestations. Previous studies conducted among nurses caring for patients with delirium have shown that nurses are often not able to detect the presence of delirium using their subjective assessments. This study evaluated the nurses’ ability to subjectively assess for delirium in patients with underlying dementia in end of life. Their findings were compared with the results of objective assessments performed by the researcher using Confusion Assessment Method. In 30 paired assessments, the objective and subjective assessments had the same findings. The remaining 20 paired assessments showed disagreement between the subjective and objective findings. A &kgr; measure of agreement was performed with a result of 0.074 and a significance of P > .05. This finding indicates no statistically significant agreement between the subjective nursing assessment for delirium and the objective assessment using Confusion Assessment Method. Accurate nursing assessment yields appropriate nursing interventions. The findings of this study support the need for improved subjective nursing assessment for delirium in patients with dementia at the end of life.

The current state of e-prescribing: Implications for advanced practice registered nurses.

Purpose:The purpose of this study was to review legislation, barriers and challenges, and current state of e‐prescribing (eRx) in the United States. Data sources:Literature search of CINAHL, MEDLINE, PubMed, and Google Scholar was performed. Conclusions:Challenges to eRx implementation and effective use include transcription, workflow issues, alert fatigue, educational and tangible reminders, and eRx of controlled substances. Implications for practice:Further research could be best focused on user‐friendly and interactive software improvements for both patient and provider use, bidirectional communication, and workflow studies to improve efficiency of eRx.

Electronic nursing care reminders: Implications for nursing leaders

OBJECTIVE: The aim of this study is to report the results of a replication study of the relationship between self-reported nursing care reminder (NCR) use and missed nursing care. DESIGN: A descriptive cross-sectional correlational design was used. The sample (N = 124) was composed of medical/surgical and ICU RNs working on acute care hospital units in a large Midwestern teaching hospital. METHODS: The MISSCARE Survey, Nursing Care Reminders Usage Survey, and the Impact of Health Care Information Technology Survey were used to collect data. Adjusted hierarchical multiple regression was used to determine study outcomes. RESULTS: Nurses who use NCRs more frequently have decreased reports of missed nursing care. Nurses who perceive the impact of healthcare technology as positive on their practice also have decreased missed nursing care. CONCLUSION: The results of this study suggest that NCRs are an effective intervention to decrease missed nursing care in acute care hospitals.

Lost opportunities...the challenges of "missed nursing care".

Learn how to define, identify, and ultimately avoid missed nursing care within your organization.

Shared Passion at the Nexus of Nursing Informatics, Systems, Policy, and Research: Midwest Nursing Research Society Advances the State of the Science

T he Midwest Nursing Research Society (MNRS), one of the largest research societies for nurses, facilitates intradisciplinary exchanges and collaboration. An important way this is done is through research interest groups or RIGs. The MNRS currently has 20 RIGs including the Health Systems, Policy and Informatics (HSPI) RIG. The membership of the HSPI RIG spans the continuum of nursing scientists from student researchers to Fulbright scholars, fellows in the American Academy of Nursing, and fellows in the American College ofMedical Informatics who address critical needs for new knowledge in informatics. In this article, we highlight a sampling of the recent published work of HSPI RIG researchers in five areas of nursing informatics research: (1) usefulness and usability of health information technologies (HITs), (2) data sciencemethods, (3) quality and safety in healthcare, (4) social and behavioral determinants of health, and (5) physical and environmental determinants of health.

Patient Satisfaction With Electronic Health Record Use by Primary Care Nurse Practitioners.

The purpose of this research study was to determine if satisfaction and communication between the patient and the nurse practitioner are affected by allowing patients to view their electronic health records during the history portion of the primary care office visit compared with patients who do not view their records. A cross-sectional, experimental design was utilized for this study. The intervention group was shown several components of the electronic health record during the history portion of the nurse practitioner assessment. This group’s scores on a patient satisfaction survey were compared with those of the control group, who were not shown the electronic health record. The study findings suggest that the introduction of the electronic health record does not affect patients’ satisfaction related to the office visit by the nurse practitioner.

Perceptions of Weight Loss Experience Between African-Americans and Caucasians: A Pilot Study

BackgroundObesity is a growing epidemic in the USA, which leads to comorbidities associated with diseases such as hypertension, diabetes, sleep apnea, cardiovascular disease, osteoarthritis, cancer, gallbladder disease, and dyslipidemia. The purpose of this study is to identify perceptions of weight loss experience between African-American (AA) and Caucasian patients undergoing bariatric surgery.MethodsA convenience sample of 31 patients participated in this study from May to June 2013. The sample size consisted of 16 AA and 15 Caucasians from two fully accredited and licensed bariatric clinics in metropolitan Detroit.ResultsThe sample (N = 31) consists of eligible AA and Caucasian presurgical bariatric patients on their first preoperative appointment. Snacking and sexual satisfaction showed a significant difference (p < 0.05), lower amongst Caucasians than amongst the AA. The results revealed that salary within the AA population was significantly lower than that of the Caucasians, especially in the